How and who manage hemodialysis inpatients at national university hospitals in Japan? Based on questionnaire survey

Background More than three hundred thousand hemodialysis (HD) patients exist in Japan. The average of vintage of Japanese hemodialysis patients was longer than Western country. Longer and older hemodialysis patients tend to have various complications to be hospitalized and treated by various departments. However, the clinical management practices for HD inpatients are not well-known. In this study, we investigated the clinical management practices for HD inpatients in national university hospitals in Japan. Methods The questionnaire-based survey was conducted among HD management specialists of 42 national university hospitals in Japan via online correspondence or letters. This survey investigated their clinical management practices for HD inpatients of other departments. The responses were obtained from 173 (69%) of 249 HD management specialists among 37 (90%) of the 42 facilities. Results The majority (87%) of HD management specialists were aware of the importance of medical intervention by HD specialists for the management of HD inpatients. However, only approximately 20% of HD management specialists regularly ordered blood examination and chest X-ray for the management of HD inpatients of other departments. Dialysis physicians with less experience faced more difficulty in managing HD inpatients of other departments, than experienced HD management specialists. The main reason for this difficulty was poor communication with the attending physicians, lack of management rules, and short duration of hospital stay of HD inpatients. Conclusions This study indicated that the clinical management practices for HD inpatients in other department were different for each HD management specialists and were affected by their clinical experience. Good communication and established inter-departmental HD management rules would be necessary. Keywords: Hemodialysis, Hospitalist, Questionnaire survey, Practice pattern, Patient care